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6 k c 7 `¢s„, (7f F t�'� � i� '°'F$` �r 'r °;" i�R <br /> r' v r f a. b ^: 'yry�p:? , "Y—'.-' `. z:�7y`'{ y.r pg„� 3 � -Y.dct <br /> 'i .r ."..,' 4 aEz ,Ms ' Riunr .a` 'pY�> _ <br /> ❑ Yes,this section applies <br /> The replacement of a Residential fixture or appliance that meets all three of the following requirements: <br /> 1. Does not require modification to electrical or gas service. <br /> 2. Has a total cost of$500.00 or less;excluding the cost of the fixture or appliance: and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> ';;g -t` '�1 - t�� 9 up k'.)k 4'�r'vE� F�` -kF #�'k•a¢.�¢'c}` ,.`'•^ a�iw*.; � b p`-+?...n p ,'tea" v, `sH a�fi <br /> 0 <br /> 40, <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> 873-7pD x.0125$ <br /> (contract price) (minimum$50.00) <br /> 2. STATE SURCHARGE **Add the State Bldg Code Div. Surcharge(Minimum Fee of$.50) <br /> x.0005 $ <br /> (contract price) (minimum$ .50) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ <br /> • * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials, labor,profit, and other fixed costs. It is the amount to be charged <br /> to the customer for the work done. If any material, equipment, labor or installations are furnished by <br /> the owner, tenant or any other party, the reasonable market value of such items must be added to the <br /> estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the <br /> amount of the job cost, the City may request the submission of a signed copy of the actual contract. <br /> • **The STATE SURCHARGE is.0005 of the Building Department at(952)249-4600 for the price. <br /> s.` <br /> .'F.� � Vcm+.',Ii€:gx rz ..> �wk;t r7".171,41 ..aeEptitAV ` I <br /> esLe•e �Sfrr' :`'F_ °°' „, <br /> /wb£ <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certifies that all statements made on this application are complete, true and <br /> correct. <br /> Applicant's Signature: Aviv`441 Date:J i o <br /> (Pr <br /> 3 <br />